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Wednesday, May 28, 2014

The Dead and the Dying, or Advanced Cancer Patients

I knew I had to write this article sooner or later. It's been such a long time that I don't even remember if I've written about a certain experience with cancer patients.

I have to tell you that oncology is a specialty for special people. To some, a "good" oncologist, or cancer doctor, manages patients well. To others, especially outside of oncology, a good oncologist also has to tell a patient their prognosis, and involve the family if the patient so desires.

It's such a disaster when there's an emergency and the patient's family or even the patient themselves doesn't have a good understanding of the severity of their disease.

My biggest struggles as a young almost-doctor has been being the medical and emotional support for patients who are actively dying from cancer.

Cancer isn't like trauma where you can ligate some vessels or resect this, or bolus fluid or give whole blood and things turn out better (in the absence of sepsis).

Cancer isn't like asthma or diabetes that you can just simply give a pretty good treatment regimen for.

Patients will present with stage IV cancer in the county hospital and in private practice. Sometimes primary cancer and especially recurrences come like an ambush in the night.

I've cried,. I've cried a lot and have hidden it from people when I come home from taking care of patients with advanced cancer and poor prognoses. Cancer can be a slow death, with paraneoplastic syndromes, with tumours encapsulating important arteries, with mets to the brain, with omental implants, encasing vital veins or arteries.

Sometimes patients cry in front of you. Sometimes they just want you to go away and get angry that you're trying to spend time with them.

I hurt so much right now and am so terribly sad, trying to take care of patients and be there for them when they suffer so much and there's so little I can do.

You can't wave a hand and have cancer go away. Not everyone responds to chemotherapy. Some patients get dragged down into deep depression and never recover.

Some patients remain positive, some have family members who never let go and want everything done even though the patient's body can't tolerate surgery or chemotherapy.

Cancer can be a death sentence that presents as "benign" as a vertebral fracture in an elderly patient. It might be an incidental finding in a young friend of yours who presents at stage IV.

I lost a friend to cancer before she could go on and live in her 20s. I think about her a lot, but everytime I interact with a very advanced cancer in a patient, I think of all the other patients I took care of.

It's hard. It breaks me. I remember almost crying on my medicine core rotation when 95% of the patients I saw had to go onto palliative care.

Medicine isn't glorious. It's full of heartbreak if you're a sensitive person. I guess the best doctors sympathise with patients, but they probably also hurt a lot in this instance.

Maybe time hardens you, the more and more you see people dying. But cancer is so different. Not everyone can prevent it or detect certain kinds easily and early. You can't cure advanced cancer by exercising daily or eating right. It's just..time that gets you. An unrelenting biochemical process.

I hope I don't cry in front of anyone tomorrow. I somehow manage to keep my composure in front of everyone during the day, but it just wears on you so much.

I give my cancer patients extra visits because I know they need it, and maybe want it. I go out of my way to give my cancer patients more time. One of the things that makes me cry is that I give my cancer patients all the time I have, even though they have little left.

I'm crying already just thinking about it. My patients are so short of breath, so cachectic, struggling just to live to the next breath and there's nothing I can do.

Oncology isn't for me. It's for a special person. So is palliative care. I'm thinking about pulling the palliative care doc and just asking them how they deal with things..It can't be easy.

My day is over. I need some time to recover. While I can go to sleep without thinking about a mass in my chest or a tumour growing around my heart or brainstem, I'm still destroyed inside.